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KEY POINTS

In- and out-of-the-hospital cardiac arrest remains a substantial public health problem and a leading cause of death in many parts of the world. There is a dramatic variation in the survival rates across various systems of care.

Major changes were made in the 2010 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care. We will review the studies behind these recommendations.

Identifying the most accurate and relevant post–cardiac arrest outcomes to measure is a major challenge. The most used measurements are survival to hospital discharge, or neurologically intact survival to discharge.

Five main components of high-performance CPR have been identified: chest compression fraction, chest compression rate, chest compression depth, chest recoil, and ventilation. Minimizing the interval between stopping chest compressions and delivering a shock improves the chances of shock success and patient survival.

The 2010 AHA guidelines recommend education to improve the effectiveness of resuscitation. Recommended educational tools include high-quality medical simulators, videos, and written tests accompanied with a performance assessment.

INTRODUCTION

Cardiac arrest is the abrupt cessation of cardiac pump function which leads to death, but in some cases can be reversible by a prompt intervention in the form of cardiopulmonary resuscitation (CPR).1 In- and out-of-the-hospital cardiac arrest remains a substantial public health problem and a leading cause of death in many parts of the world.2 In the United States and Canada, approximately 350,000 people/year suffer a cardiac arrest (approximately half of them in-hospital) and receive attempted resuscitation; approximately 25% of these present with pulseless ventricular arrhythmias.3,4 Cardiac-arrest victims who present with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) have a substantially better outcome compared with those who present with asystole or pulseless electrical activity (PEA).4 Emergency systems that can immediately and effectively implement life support measurement can achieve witnessed VF cardiac arrest survival of almost 50%.5 However, there is a dramatic variation in the survival rates across various systems of care, with the most successful systems reporting survival rates five times higher than the least successful.3

The survival rate and the quality of life (specially measured as a neurological performance) after a cardiac arrest have also changed over time; for example, the US survival rates for hospitalized patients with cardiac arrest improved from 30.4% in 2001 to 42.2% in 2009 as per the US National In-Patient Sample, a national hospital discharge database.6 It is important to understand that CPR outcomes are significantly influenced by the underlying pathology and the initial cardiac rhythm at the time of the cardiac arrest. In a nutshell, survival is best for patients with VT or VF.

It is an integrated and coordinated system, starting from initial responders (including both medical professionals and bystanders) to in-hospital caregivers, functioning as a comprehensive whole that will produce the highest likelihood of achieving the desired survival to discharge from ...